Chessells J M, Breatnach F
Br Med J (Clin Res Ed). 1981 Sep 19;283(6294):749-51. doi: 10.1136/bmj.283.6294.749.
Thirty children with acute lymphoblastic leukemia had a recurrence in the bone marrow after treatment was stopped electively. A second haematological remission was achieved in 27 (90%), and the median duration of remission was shortest (six months) in those relapsing within six months of stopping treatment. Four of six children relapsing over one year after stopping treatment remained in second haematological remission. Leukaemic infiltration of the central nervous system developed in four patients remaining in marrow remission. It is concluded that conventional chemotherapy is unlikely to be effective in children with acute lymphoblastic leukaemia who relapse soon after stopping treatment, that "reprophylaxis" of the central nervous system probably with long-term intrathecal chemotherapy is essential, and that some patients relapsing after prolonged unmaintained remission may achieve long-term leukaemia-free survival.
30例急性淋巴细胞白血病患儿在选择性停止治疗后出现骨髓复发。27例（90%）实现了第二次血液学缓解，在停止治疗后6个月内复发的患儿中，缓解的中位持续时间最短（6个月）。6例在停止治疗1年后复发的患儿中有4例仍处于第二次血液学缓解状态。4例骨髓缓解的患者发生了中枢神经系统白血病浸润。得出的结论是，常规化疗对停止治疗后很快复发的急性淋巴细胞白血病患儿可能无效，对中枢神经系统进行“预防”（可能采用长期鞘内化疗）至关重要，并且一些在长期未维持缓解后复发的患者可能实现长期无白血病生存。
